Crisis in mental health beds in Washington headed toward lawsuit?

The word crisis gets thrown around a bit too much in social services, but it’s not hyperbole to call the shortage of inpatient psychiatric care a real crisis.

As I wrote last month, a quarter of the patients who need immediate hospitalization instead get parked emergency rooms – or “boarded,” as it’s known – for days, strapped down in hallways, not getting better, because there’s not enough hospital beds for them. Imagine the outcry if that sentence were written about breast cancer patients, or pulmonary disease. But sub in mental health crisis, and the response seems a resigned sigh and shrug.

Washington ranks, by varying measures, 51st or 47th in community psychiatric hospital beds, where patients go for short stays. Western State Hospital, the longterm resource for civil and criminal forensic beds, has shrunk by hundreds of beds. The Legislature, amid a budget crisis, allowed the mental health system to wither into total dysfunction.

Last week, Pierce County Superior Court Commissioner Craig Adams declared the Washington Administrative Code on “single bed certification” – which legally turns a emergency room hospital bed into a temporary, one-patient psychiatric ward – to be unconstitutional, for many of the reasons above. It’s interesting reading. He had some caveats, and there’s questions about his ability to make such a sweeping ruling, as the News Tribune’s Sean Robinson‘s noted this weekend.

It is also, as a wrote earlier, is dangerous to nurses, demoralizing for hospitals and head-slappingly inefficient with our scarce public dollars. Not to mention humiliating to patients, who are sick because of an unlucky roll of the genetic dice.

All of that makes the issue is “ripe” for a class-action lawsuit, said Emily Cooper of Disability Rights Washington. She’d know: DRW, a federally-funded watchdog, has a strong record such lawsuits, including at Western State Hospital. DRW just released a sad but compelling report on mentally people held in squalid solitary confinement cells in jails for weeks, even months, awaiting court-ordered evaluations at Western State. (Their video new release is below.)

She’s not threatening, and there’s no immediate plans to sue, she said. But she noted that an earlier case in Ninth Circuit Court Court of Appeals, as well as an earlier state Supreme Court opinion, are guide maps. “Because the hospital can’t get people in or evaluated, they’re continuing to get worse, they’re strapped down in gurneys in the halls of ERs, or they’re in jail cells smearing themselves with their own feces. There is real harm being done. That’s what makes this ripe for a lawsuit,” she said.

The Legislature can fix this. House Bill 1777, and it’s companion, Senate Bill 5480, would force creation of more inpatient psychiatric beds, easing the patients-in-hallways crisis at emergency rooms. House Bill 1627, and companion Senate Bill 5551, would grease the gummed-up process for competency evaluations. And the budget needs to include funding to make this happen.

If it doesn’t, the state is going to face a very expensive lawsuit, which will take future funding decisions out of its hands. What’s it going to be?